Provider Demographics
NPI:1639457393
Name:ASPEN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ASPEN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAIRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-760-6863
Mailing Address - Street 1:312 STEELE ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4454
Mailing Address - Country:US
Mailing Address - Phone:307-760-6863
Mailing Address - Fax:
Practice Address - Street 1:312 STEELE ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4454
Practice Address - Country:US
Practice Address - Phone:307-760-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty